Provider Demographics
NPI:1104447440
Name:HERRING, LAURIE A (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:HERRING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 454
Mailing Address - Street 2:BOX # 3417
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 8156 CHEYENNE BLVD
Practice Address - Street 2:
Practice Address - City:ANSBACH
Practice Address - State:DE
Practice Address - Zip Code:91522
Practice Address - Country:DE
Practice Address - Phone:314-520-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
UT11686899-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker